Pay your bill
We're moving to a new billing system. To make sure your payment is posted correctly, it's important to select the correct option below based on your date of service.
Make a payment
Pay through the U.S. Bank payment portal. This portal works best with Chrome, Firefox or Microsoft Edge.
Pay with MyChart
Log in to MyChart and send payment through your account.
Pay as guest
You’ll need the account number and last name of the account holder.
Self-pay means you're paying the bill yourself. Bills for services won't be sent to or processed by your insurance company.OR
Prompt pay is for patients who don't have insurance and are paying for their care themselves.
Uninsured patients can save 15% by paying the balance in full at the time of service or upon receipt of the first statement.
Prompt pay does not include cosmetic care and retail items.OR
If you're using insurance, we'll collect your copay at the time of service and bill your insurance company for you. They'll send an explanation of benefits (EOB) to us. Then we'll bill you for the rest of the balance.
If you have questions, please call 1-206-860-4500.OR
If we aren’t contracted with your insurance company, we may be able to submit courtesy billing for you.
At the time of your visit, we’ll ask you to sign a waiver. It states that you are financially responsible for all services received if your insurance company doesn’t pay.
Courtesy billing is a service we offer our patients. You are still financially responsible for your account. You’ll keep getting a statement until your account is paid in full.OR
- American Express®
- By check as an electronic funds transfer (U.S. Bank only)
- FSA or HSA (the remaining balance of your account may appear on the receipt)
- Gift card or prepaid card
If your account balance is more than $200, you can ask for an interest-free payment plan through U.S. Bank.OR
P.O. Box 3753
Seattle, WA 98124-3753OR
Other billing information
If you're uninsured or a self-pay patient, you can ask for a written good faith estimate of expected charges before you receive services. Requests for an estimate must be made at least three days before your appointment.OR
Call 1-206-860-4500. If we find you are due a refund, we’ll send you a refund check within 10 to 14 business days.OR
Each member of your family will get a monthly billing statement as needed. Your first statement includes information for your insurance company and your personal records.
You'll find more instructions and information on the back of your statement. The Polyclinic also has a payment plan for patients in good standing. See below.OR
We understand that there are times when you may need an extended payment plan. To apply for financial help, please complete the confidential financial statement below.
Mail it to:
P.O. Box 3753
Seattle, WA 98124-3753
To speak with a financial services counselor, please call 1-206-860-4500.OR
Please carry your L&I or Washington State Department of Labor and Industries claim number with you at all times. You’ll need to show this number when you check in for your visit.
Ask your employer if it has the billing forms you need. We have forms for all state-insured companies. If you’re not sure which form to use, ask your employer. You’ll need to fill out an accident report if you arrive without a self-insured claim form.OR
When you get emergency care or care from an out-of-network provider at an in-network hospital or same-day surgical center, you're protected from surprise billing or balance billing.OR